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Flashcards in Peds - Eyes and Ears Deck (52):
1

A common staphlococcal abcess on upper or lower eyelid with ABRUPT onset; PAINFUL

Hordeolum / Stye

2

When to refer hordeolum?

If no resolution within 48 hours

3

Management of hordeolum
(2)

Warm compresses
Consider bacitracin on erythromycin ophthalmic ointment

4

A non-tender beady nodule (granuloma) on the eyelid; c/b infection or retention cyst of the meibomian gland

Chalazion

5

Management of chalazion

Warm compresses
Refer for surgical removal

6

Chalazion - signs and symtoms
(7)

PAINLESS and may have:

Light sensitivity
Visual distortion if pressing on lens

7

Conjunctivitis with purulent discharge is associated with:

bacterial cause

8

Conjunctivitis with COPIOUS purulent discharge is associated with:

Gonococcal cause

9

Conjunctivitis with stringy discharge is associated with:

allergic cause

10

Conjunctivitis with watery discharge is associated with:

viral cause

11

Conjunctivitis which is bright red and irritated is associated with:

herpes

12

Treatment of CHEMICAL conjunctivitis
(2)

self-limiting
flush with water

13

Treatment of BACTERIAL conjunctivitis
(3)

o erythromycin ophthalmic
o tetracycline
o polymyxin B ophthalmic

14

Treatment of GONOCOCCAL conjunctivitis (2)

Penicillin G - IV
Ceftriaxone - IM

15

Treatment of CHLAMYDIAL conjunctivitis
(2 with examples of second - class and drugs)

o erythromycin ophthalmic OINTMENT
o ORAL therapy - tetracyclines or macrolides
tetracycline
doxycycline
erythromycin
clarithromycin
azithromycin

16

Treatment of ALLERGIC conjunctivitis

o oral antihistamines
o refer to allergy and ophthamology

17

Why are ophthalmic steroids not used in primary care for conjuncitivitis?

risk of:
increased intraocular pressure
activation of herpes simplex virus

18

When should conjunctivitis be cultured?

baby under 30 days old
suspect gonorrheal cause in any age

19

Treatment of VIRAL conjunctivitis
mild
mod
severe

mild --> refrigerated NSS gtts

mod --> decongestants, antihistamines, mast cell stabilizers, NSAIDS

severe --> sulfacetamide for bacterial prophylaxis

20

Treatment for HERPETIC conjunctivitis

Refer to ophthamlogist

21

An abnormal, uniform, progressive opacity of the eye often seen with co-morbid conditions.

Cataract

22

What co-morbid conditions are associated with CATARACTS?
(4)

o Down's syndrome
o DM
o Marfan
o Atopic dermatitis

23

Possible causes of cataracts
(5)

o congenital
o prolonged steroid use
o infection
o injury
o radiation

24

NP management of cataracts

Refer for surgery

25

Ocular misalignment as a result of uncoordinated ocular muscles

Strabismus / lazy eye

26

When is strabismus a concern?

o prior to 6 months, considered WNL
o if acquired after 6 months, usually due to underlying problem

27

What finding in strabismus is associated with a brain tumor?

hypertropia - eyes deviate upward
hypotropia - eyes deviate downward

**immediate referral**

28

A rapidly developing cancer that develops from the immature cells of a retina; the most common malignant tumor of the eye in children.

Retinoblastoma

Recognize and Refer

29

Inflammation of the external auditory meatus

Otitis externa / Swimmer's ear

30

Possible causes of otitis externa

Bacterial (gram-negative)
Fungal
Viral

31

Otitis externa - signs and symptoms

o purulent drainage
o otalgia
o pruritis

32

Management of otitis externa (2)

bacterial --> acetic acid + hydrocortisone
cortisporin (neomycin, polymyxin)

fungal --> clotrimazole solution

33

Microbes commonly implicated in acute otitis media

S. pneumoniae - 30%
H. influenza - 20%

34

Pain management for otitis media

o acetominophen
o benzocaine otic gtts

35

When is "watchful waiting" appropriate for acute otitis media?
(4)

o child over 4
o unilateral
o mild
o parent educated about red flags

36

Red flags during watchful waiting in AOM?
(4)

o change in appetite
o fever
o vomiting
o irritability

37

Treatment for acute otitis media (1)

Amoxicillin

38

Prevention of acute otitis media
(4)

o Hib
o PCV13
o influenza vaccine
o avoid second hand smoke

39

When to refer to ENT for possible tubes in acute otitis media?

3x / year
2x / 6 mo

40

The presence of fluid in the middle ears without the signs or symptoms of AOM.

Serous otitis media / Otitis media with effusion

41

Weber / Rinne results indicate which type of hearing loss in Otitis media with effusion?

Conductive hearing loss

42

Management of Otitis media with effusion?

Re-evaluate in 3-6 months

ABT and decongestants -- not effective

43

Any degree of impairment in the ability to apprehend sound.

Hearing loss

44

Types of hearing loss

conductive
sensorineural

45

Causes of conductive hearing loss (4)

Cerumen/foreign body
Hematoma
Otitis media
Perforated TM

46

Causes of sensorineural hearing loss (4)

CNS disease
Syphilis
Med toxicity - vanco, gent
Acoustic neuroma

47

Which is greater AIR conduction or BONE conduction

by how much?

AIR conduction > BONE conduction

air conduction should be TWICE as long as bone

48

What test compares air and bone conduction?

Rinne

49

Normal findings in Rinne test?

AC > BC

50

Normal findings in Weber test?

sound equal in both ears

51

Conductive hearing loss -
Weber
Rinne

Weber - sound is louder in AFFECTED ear
Rinne - abnormal (BC > AC)

52

Sensorineural hearing loss -
Weber
Rinne

Weber - sound is louder in the UNAFFECTED ear
Rinne - normal (AC > BC) tho both suppressed